Provider Demographics
NPI:1700815792
Name:ORTEGA, ANITA BARBARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:BARBARA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 AVENTURA WAY
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3362
Mailing Address - Country:US
Mailing Address - Phone:719-369-8569
Mailing Address - Fax:719-561-0791
Practice Address - Street 1:5642 AVENTURA WAY
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3362
Practice Address - Country:US
Practice Address - Phone:719-369-8569
Practice Address - Fax:719-561-0791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12050828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38820862Medicaid